Urinary bisphenol A and serum lipids: a meta-analysis of six NHANES examination cycles (2003–2014)
Linda Dunder, 1 Margareta H Lejonklou, 1 P Monica Lind, 1 Lars Lind 2
To cite: Dunder L, Lejonklou MH, Lind PM, et al. J Epidemiol Community Health 2019;73:1012–1019.
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Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden Correspondence to Linda Dunder, Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala university, Uppsala 75185, Sweden;
linda. dunder@ medsci. uu. se Received 23 April 2019 Revised 12 July 2019 Accepted 14 July 2019 Published Online First 24 September 2019
► http:// dx. doi. org/ 10. 1136/
jech- 2019- 213213
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background Mounting evidence from both experimental and epidemiological studies suggest that exposure to the endocrine disruptor bisphenol A (BPA) has a role in metabolic disorders. The aim of the present study was to assess whether urinary BPA concentrations were associated with dyslipidaemia in children (≤17 years old) and adults (≥18 years old) by performing a meta-analysis of data from six cycles (2003–2014) in the National Health and Nutrition Examination Survey (NHANES).
Methods We conducted a meta-analysis of data from 4604 children and 10 989 adult participants who were part of a substudy of urinary BPA measurements from six NHANES cycles from 2003 to 2014. Linear regression models conducted in each cycle were used to perform a meta-analysis to investigate associations between urinary BPA and serum levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglycerides (TG) and apolipoprotein B (ApoB).
results The meta-analysis did not disclose any significant associations between urinary BPA concentrations and LDL-C, HDL-C, TC, TG and ApoB in children. In adults, the meta-analysis revealed negative regression coefficients for all five lipid variables. However, no associations were significant following Bonferroni correction for multiple tests.
Conclusions In the present meta-analysis of cross- sectional data from NHANES, no associations were found between urinary BPA and the five different lipid variables when investigated in both children and adults.
However, considering the cross-sectional nature of the present study, results should be clarified in carefully designed longitudinal cohort studies with repeated BPA measurements.
The ‘obesogen hypothesis’ and ‘metabolism-dis- rupting hypothesis’ suggest that exposure to endo- crine-disrupting chemicals (EDCs) found in the environment may predispose some individuals to the development of obesity and associated health conditions, such as type 2 diabetes and cardiovas- cular diseases. Bisphenol A (BPA) is one of the most commonly reported obesogens and metabolism-dis- rupting chemicals.1 2
BPA is a high-volume chemical extensively used in epoxy resins lining in food and beverage containers and as a monomer in polycarbonate plastics in many consumer products. Its use is still abundant and environmental contamination is apparent in waters, sediments, soil, air, wildlife and humans.3
to BPA, primarily via food, but also through dental sealants, thermal paper (receipts and tickets), dermal exposure and inhalation of household dust, is evident from the detectable levels of urinary BPA in humans.4–8
BPA has also been detected in adipose tissue,9
and urinary BPA concentrations do not decline rapidly with fasting time, implying that BPA partly accumulates in adipose tissue and other tissue compartments.10 11
BPA can interfere with multiple hormone actions,12
including the activity of membrane and nuclear receptors (eg, oestrogen receptors), thyroid hormone receptor, androgen receptor and orphan receptors (eg, aryl hydrocarbon receptor). The diversity of plausible mechanisms of BPA, in addi- tion to the dose in relation to exposure during sensi- tive windows, may be an explanation for the effects of low-dose BPA exposure on endocrine systems.13
In humans, BPA exposure has been associated with the metabolic syndrome14
and its components hypertension,15
diabetes mellitus,16 17
insulin resis- tance18
and obesity.19 20
Especially troublesome is that associations between BPA exposure and meta- bolic diseases are observed also in children,20–23
indicating that metabolic disturbances due to BPA exposure start at a young age.
Because of the intense focus on BPA, several studies using National Health and Nutrition Exam- ination Survey (NHANES) data to address the link between BPA and metabolic disorders such as obesity and diabetes already exist. However, to our knowledge, studies investigating the rela- tion between BPA exposure and dyslipidaemia are limited.16 23
Thus, the aim of the present study was to investigate potential associations between urinary BPA concentrations and dyslipidaemia in US children and adults by performing a meta-anal- ysis of data from six NHANES cycles from 2003 to 2014. We hypothesised that urinary BPA, as a surrogate biomarker for BPA exposure, is associated with a disturbed lipid metabolism.
MeThods study population
NHANES is a continuous cross-sectional surveil- lance programme administered by the National Center for Health Statistics, which is part of Centers for Disease Control and Prevention (CDC). The aim of NHANES is to assess the health and nutritional status of the general US population for both children and adults. A detailed description of the NHANES study design and methods is available elsewhere.24
Results in the present study are based on data from the
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Cycle 2003–2004 2005–2006 2007–2008 2009–2010 2011–2012 2013–2014